Glossary

A reflection of the cost of premiums for workers compensation as a percentage of the reported NSW wages bill.

The premium value used for the Nominal Insurer is calculated as total premium payable net of GST and levies, such as the dust disease levy and mine safety levy. The premium for self-insurers is deemed premium, calculated as wages covered multiplied by the premium rate applicable for the appropriate industry class.

The premium for Government self-insurers (TMF) is the value of the deposit contributions made by each member agency. The premium for specialised insurers is the gross written premium, net of GST and levies, such as the dust disease levy and mine safety levy.

Premium information is updated annually.

Average duration of weekly payments paid in the first six months. This measure shows the average number of days of weekly benefits paid to workers in the first 6 months of their injury. The measure uses work hours lost to calculate average days.

The measure compares the quarters benchmarked across the previous quarters. The chart shows the average number of days of weekly benefits paid to workers in the first 6 months of their claims. This measure uses work hours lost and injury quarter to calculate the average days.

Note: the data for these measures requires six months to development.

A claim for workers compensation or work injury damages that a person has made or is entitled to make under the Workplace Injury Management and Workers Compensation Act 1998.

The injury or illness may be physical or psychological, but employment must be a substantial contributing factor to injury for compensation to be payable.

Note that police officers, paramedics, fire fighters, volunteer bush fire fighters and emergency and rescue services volunteers may be able to claim for injury suffered during journeys to and from work or place of volunteering without the need to show a real and substantial connection with employment.

This report includes claims from workers whose employer is uninsured. Where a split by insurer segment is shown, claims of uninsured employers are included with the Nominal Insurer segment. This report excludes claims for:

• dust diseases. These are administered by the Dust Diseases Authority.
• workers who are self-employed.
• employees of the Australian Government.
• a member of the NSW Police Force who is a contributor to the Police Superannuation Fund under the Police Regulation (Superannuation) Act 1906.

This graph shows the costs each month for weekly payments.

The financial and cost information in this report is presented in original dollar values with no indexation applied. Costs in the Workers Compensation system are subject to a variety of potential inflationary factors including wage and salary rates, medical fee schedules, statutory benefits indexation and general price inflation. As there is no single index which adjusts for all potential factors, costs have been shown in the original dollar values for simplicity.

The NSW State Insurance Regulation Authority (SIRA) is committed to producing data that is accurate, complete and useful. Notwithstanding its commitment to data quality, SIRA gives no warranty as to the fitness of this data for a particular purpose. While every effort is made to ensure data quality, the data is provided “as is”. The burden for fitness of the data rests completely with the user.

SIRA shall not be held liable for improper or incorrect use of the data.

Please note, this data was correct at the time in which it was extracted, however may change due to the progression of data and the application of regular data quality reviews. There are several areas where SIRA is actively working on the methodologies and data sets with the view to improving the measures and the capability to monitor the system.

Customers’ perception of how equitably, fairly and justly they were treated is an important measure of the performance of the system.

The SWA 2018 RTW survey included asking workers about their perceptions of equity. Workers rated their experience across these four broad dimensions of equity and perceived justice:

• distributive justice, about the fairness of their compensation
• informational justice, in receiving accurate and timely information about the rationale for decisions
• interpersonal justice, on whether they were treated with respect and sensitivity
• procedural justice, about the fairness of the procedures used to determine the outcomes.

Survey respondents rated their agreement with a range of specific attributes on a five-point scale. For the SWA 2018 RTW survey, a range of specific attributes were measured within each of these four dimensions, comprising some 15 attributes. A higher mean score denotes a higher level of agreement (or a higher perceived sense of justice/fairness).

Major injuries/claims are defined as those that satisfy the following conditions:

The claim entered the insurer’s/scheme agent’s computer system within the analysis period (for example, on or after 1 July 2018 and on or before 30 June 2019 for financial year 2018/19).

The injury resulted in death, permanent disability, or temporary disability with at least one week of weekly benefit entitlement paid.

The data presented in this report are derived from monthly claims submission data, annual declarations provided to SIRA from NSW workers compensation insurers, the Workers Compensation Commission and the Workers Compensation Independent Review Office.

The financial and cost information in this report is presented in original dollar values with no indexation applied. Costs in the workers compensation scheme are subject to a variety of potential inflationary factors including wage and salary rates, medical fee schedules, statutory benefit indexation and general price inflation. As there is no single index which adjusts for all potential factors, costs have been shown in their original dollar values for simplicity.

The premium value used for the Nominal Insurer in this report is calculated as total premium payable net of GST and levies, such as the dust disease levy and mine safety levy. Premium for self-insurers is deemed premium, calculated as wages covered multiplied by the premium rate applicable for the appropriate industry class. Premium for Government self-insurers (TMF) is the value of the deposit contributions made by each member agency. Premium for specialised insurers is the gross written premium, net of GST and levies, such as the dust disease levy and mine safety levy.

Insurers regularly update claims data based on the progression of a claim. This may result in changing claim details month on month.

Payments data a is broken up into two payment classification groups which are as follows:

Payment Classification level 1 provides a high-level breakdown of workers compensation payments.

Payment Classification level 2 provides a further breakdown of the categories in payment level 1, where applicable. For example, Investigation in payment level 1 is broken down into Insurer Investigation Expenses and Worker Investigation Expenses in payment level 2.

The Perceived Justice of the Compensation Process series of measures is a scale that has been used widely in research related to workers compensation and return to work outcomes. It measures injured or ill workers’ perceptions of fairness of their workers’ compensation experience across four broad dimensions – the details of their compensation arrangement, the claim process, information provision and interpersonal communications.

Definitions of dimensions used to measure customer perception of equity and perceived justice

Procedural justice, about the fairness of the procedures used to determine the outcomes

Informational justice, is about receiving accurate and timely information about the rationale for decisions

Interpersonal justice, relates to whether workers are treated with respect and sensitivity

for more information refer to the published Abridged Return to Work Outcomes Survey: NSW Workers Compensation System October 2019. https://www.sira.nsw.gov.au/__data/assets/pdf_file/0009/584919/Abridged-RTW-Outcomes-Survey-NSW-Workers-Compensation-System-Oct-2010.pdf

If any claims payments under Bodily location, Nature or Mechanism of injury have been mapped to the cohort called (Pre 2011 Code), this generally means some of the payments made for claims that began commenced prior to July 2011 either haven’t or cannot be coded to the latest Type of occurrence classification system (TOOCS) 3rd Edition.

Type of occurrence classification system (TOOCS) 3rd Edition May 2008 is designed primarily for use in the coding of workers’ compensation claims, but it can also be used by employers in the workplace.

The Type of Occurrence Classifications System, Version 3.0 (TOOCS3.0) was developed to improve the quality of the NDS data by enabling jurisdictions to code more consistently and reduce the use of dump codes. This improvement in data quality will enhance the efficacy of all reports that rely on this data. This revision of TOOCS3 (TOOCS3.1) contains some significant improvements, most notably a clarification of the hierarchy contained in the Agency chapter. Please refer to https://www.safeworkaustralia.gov.au/doc/type-occurrence-classification-system-toocs-3rd-edition-may-2008 for further information.

Recoveries of workers compensation payments. These include recoveries received from the employer for the amount of their prescribed excess, recoveries in relation to common law settlements, recoveries relating to claims involving more than one insurer, recoveries received when an injury was caused under circumstances creating liability for some person other than the workers' employer to pay damages and recoveries of over-payments made to a person.

(Sections 151A, 151Z, 160 and 235 of the Workers Compensation Act 1987, Section 74 of the Insurance Contracts Act 1984, Sections 235D and 272 of the Workplace Injury Management and Workers Compensation Act 1998).

Recoveries of workers compensation payments. These include recoveries received from the employer for the amount of their prescribed excess, recoveries in relation to common law settlements, recoveries relating to claims involving more than one insurer, recoveries received when an injury was caused under circumstances creating liability for some person other than the workers' employer to pay damages and recoveries of over-payments made to a person.

(Sections 151A, 151Z, 160 and 235 of the Workers Compensation Act 1987, Section 74 of the Insurance Contracts Act 1984, Sections 235D and 272 of the Workplace Injury Management and Workers Compensation Act 1998).

A reportable claim for workers compensation or work injury damages is a claim that a person has made or is entitled to make under the Workplace Injury Management and Workers Compensation Act 1998. Claims become reportable once they meet certain liability conditions and/or have received payments. For example, the injury or illness may be physical or psychological and employment must be a substantial contributing factor to injury, except for those claims made by police officers, paramedics, fire fighters, volunteer bush fire fighters and emergency and rescue services volunteers for injuries suffered during journeys to and from work or place of volunteering.

Reportable claims include claims from workers whose employer is uninsured. Where a split by insurer segment is shown, claims of uninsured employers are included with the Nominal Insurer segment.

Reportable claims exclude administration error claims, claims closed with zero gross incurred cost, claims shared between two or more workers compensation agents/insurers and the agent/insurer is not responsible for the management of the claims, and claims with payments only for recoveries, vocational programs or invalid payment classification numbers.

Reportable claims also exclude claims for:

• dust diseases (administered by the Dust Diseases Authority)
• workers who are self-employed
• employees of the Australian Government
• a member of the NSW Police Force who is a contributor to the Police Superannuation Fund under the Police Regulation (Superannuation) Act 1906.

This chart shows claim payments by accident year. That is, comparing payments of accidents occurring in the 2019/20 financial year with the prior accident period at the same stage of development. This chart allows for like for like comparisons across financial years and is presented in original dollar values with no indexation applied.

The financial and cost information in this report is presented in original dollar values with no indexation applied. Costs in the workers compensation scheme are subject to a variety of potential inflationary factors including wage and salary rates, medical fee schedules, statutory benefit indexation and general price inflation. As there is no single index which adjusts for all potential factors, costs have been shown in their original dollar values for simplicity.

Note the customer impacted by Section 39 of the act that exited the system up to June 2018 are excluded

The Return to work (RTW) rate is the percentage of workers who have been off work as a result of their employment-related injury/disease and have returned to work at different points in time from the date of injury (i.e. 4, 13, 26, 52 and 104 weeks for the SIRA Stats report).

The cohort for each RTW measure for each reporting month is based on claims with injuries occurring in a 12 month period, with a lag period corresponding to the measure timeframe, to allow for claim development. This ensures that the newest claims to reach maturity for that particular measure are included in the relevant reporting month.

Calculation method for 4-week measure for November 2018 is given below as an example:

1. Total number of time lost claimants = Claims injured from November 2017 to October 2018.

2. Total number of claimants back at work in 28 days (based on work status codes 1, 2, 3 & 4) with any capacity.

RTW Rate = b/a multiplied by 100.

The deterioration in RTW across the system is largely driven by the performance of the NI and has been the subject of a compliance and performance review. See findings here.

The self insurers RTW performance is deteriorating to a lesser degree and SIRA is currently analysing this. Whilst at a very preliminary stage, initial exploration reveals the RTW performance is impacted by several variables including data quality and completeness from insurers. Once SIRA has completed the analysis we will report more fully on this aspect of the system performance.